Health Equality For All
As a result of experiences arising out of the Great Depression of the 1930s and wartime experiences of the 1940s, Canada decided to follow other western developed countries and set up a welfare state organization to promote full employment and provide social supports for those who needed social care. But in 1945-46 efforts to introduce new programs of federal grant aid to enable the provincial governments to set up better service delivery schemes were thwarted, at first, by two provinces which raised constitutional objections to the federal government involvement in social affairs. These objections were ultimately overcome, but there were long delays in implementing federal plans and the Canadian welfare state was not in place until the end of the 1960s. In the meantime the Province of Saskatchewan led the others in developing a plan for providing a provincial level of collectivist health care. Other English-speaking provincial governments were not so far ahead in their thinking as Saskatchewan, but they could see electoral advantages in sup- porting welfare state approaches. After Ontario’s resistance to federal intervention was removed in 1957, the provinces were able to claim open-ended matching grants and to set up a wide range of social programs. Quebec made a separate deal with the federal government in 1963 which enabled that province to claim grant aid on its own terms. Quebec’s planning activities influenced the new federal Deputy Minister of Health and Welfare Dr. Maurice Le Clair, appointed in the late 1960s. He raised a series of questions about the management of federal grant aid by the provinces and whether the current aims of the health care programs, that were to provide access to hospital and medical care, were really good enough for a collectivist system of care. By proposing that the emphasis on access should be shifted to concern for outcomes, he altered the model for health care from a biomedical to a social model. There were many resistances to changing the model of care. First there were the constitutional resistances by the provinces to any federal intervention into social affairs. Then there were resistances of the medical profession to changes in practice organization. Compromises had to be made to the rational plans of Saskatchewan and Quebec. The doctors continue to maintain the organizational structures which were developed for providing individualistic health care before the war. Few changes to these have been accepted. While public health staffs have been more ready to consider organizational change, this acceptance may still be rhetoric rather than reality. Care for the elderly is also threatened by medical resistance to change from the biomedical to the social model of care proposed by Le Clair. The welfare state developments restricted community members from making inputs into decision making about social care.
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